A bill toughening regulations for medical-marijuana patients and doctors won its first vote before the full state Senate on Friday, but not before seeing two significant changes.

The bill would require doctors recommending marijuana have a more involved relationship with the patients they recommend it to, and it would bar medical-marijuana dispensaries from paying doctors to write referrals. The measures are intended to stop assembly-line-style abuse of the medical-marijuana system.

Amendments added to the bill Friday eliminated a requirement that patients receive follow-up care from the doctor who wrote their marijuana recommendation. State Sen. Pat Steadman, D-Denver, said doctors should offer follow-up care but that the state shouldn't mandate patients be locked into a relationship with a doctor.

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Another amendment will require patients between the ages of 18 and 21 to get a second recommendation before being allowed onto the state's medical-marijuana registry. Amendment supporters said the change would prevent young people from exploiting the lawful medical system for illegal recreational use, but other lawmakers said the amendment is unfairly restrictive and threatened to vote against the bill if it remains.

The Senate must give the bill one last, recorded vote before the measure goes to the state House for its consideration.

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